الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Depot medroxy-progesterone acetate (DMPA) is a
widely used long acting contraceptive, given as 150 mg IM
injection every 90 days. It inhibits proliferation of ovarian
follicles, resulting in an-ovulation and a decrease in
circulating estrogen, the later action is potentially
disadvantageous to cardiovascular health especially
atherosclerosis.
Oxidative modification of low density lipoprotein
(LDL) play a key role in the pathogenesis of atherosclerosis
as it induces an immunogenic epitopes in LDL molecule and
the presence of antibodies against OX-LDL has been
demonstrated in human sera. Also the level of auto
antibodies against OX-LDL has been taken as an index of
the oxidant status of LDL.
The aim of this work is to study the level of auto
antibodies against oxidized low density lipoprotein and to
evaluate the risk of atherosclerosis in DMPA users.
Summary & Conclusions
566
This study includes forty women aged between 25-40
years. All subjects received DMPA as a method of
contraception every 12 weeks for two years continuously.
Non of our patients were diabetic, hypertensive or
cardiac. We also excluded females with over weight, history
of thromboembolism, liver disease or impairment, lipid
disorders, also females with suspected malignancy and users
of hormonal contraceptives in the last one year.
All the studied groups were subjected to the following:
a- Full history taking.
b- Thorough clinical examination.
c- Routine laboratory investigations.
d- Estimation of serum total cholesterol.
e- Estimation of serum LDL – C.
f- Estimation of serum HDL- C.
g- Estimation of serum triglyceride level.
h- Estimation of auto antibodies against oxidized LDL
by ELISA technique .
The results obtained after one and two years of DMPA
use were compared with the pre- treatment values and the
following changes were reported:
Summary & Conclusions
561
1) There was a significant increase in the mean body
weight after one and two years (p- value <0.05).
2) No statistically significant change was detected in
the mean systolic and diastolic blood pressure after
one and two years of DMPA use
3) Significant increase in total cholesterol level after one and
two years of DMPA use
4) Significant increase in LDL-C after one and two years
of DMPA use.
5) Significant decrease in HDL-C after one and two
years of DMPA use.
6) No significant change in triglyceride level after use of
DMPA for one and two years.
7) Significant increase in TC/HDL-C index after one and
two years use of DMPA.
8) LDL- C/ HDL-C shows significant increase after one
and two years of DMPA use.
9) There was mild non significant increase of autoantibodies
against OX- LDL-C after one year of
DMPA use and a significant increase of it has
occurred after two years.
Summary & Conclusions
561
10) In DMPA users there was no correlation between
OX-LDL auto antibodies and TC after one year but
after two years there was a significant positive
correlation. However significant positive correlation
between OX-LDL auto antibodies and LDL- C after
one and two years has been existed, while significant
negative correlation between OX-LDL auto antibodies
and HDL-C after two years was observed has been
demonstrated. No correlation between OX- LDL auto
antibodies and TG. On the other hand significant
positive correlation between OX-LDL auto antibodies
and weight increase after one and two years and no
correlation between OX- LDL auto antibodies and
blood pressure was found.
Conclusions:
1- The risk of atherosclerosis was evident after one
year use of DMPA and it increased with the
duration of use.
2- Oxidative modification of LDL renders it
immunogenic and auto antibodies against it were
found in serum.
Summary & Conclusions
561
3- Auto antibodies against OX-LDL can be used as a
diagnostic marker of atherosclerosis.
4- The elevation in the level of OX-LDL auto
antibodies may be associated with an increased
extent of atherosclerosis.
5- The aforementioned data, previous and present
findings of metabolic effects of DMPA may
constitute an important risk factor for cardiac
disease through the initiation of risk factors that
have been related to insulin resistance syndrome.
The findings of this study need to be confirmed by
further larger studies to evaluate the real size of the risk of
atherosclerosis and the role of OX-LDL auto antibodies in
the pathogenesis of atherosclerosis in DMPA users.